Major Jonathan Letterman[1] (December 11, 1824 – March 15, 1872) was an Americansurgeon credited as being the originator of the modern methods for medical organization in armies or battlefield medical management. Dr. Letterman is known today as the "Father of Battlefield Medicine." His system or organization enabled thousands of wounded men to be recovered and treated during the American Civil War.

Civil War

At the start of the Civil War, Letterman was assigned to the Army of the Potomac. He was named medical director of the Department of West Virginia in May 1862. A month later William A. Hammond, Surgeon General of the U.S. Army appointed him, with the rank of major, as the medical director of the Army of the Potomac itself.[5][6] Letterman immediately set to reorganizing the Medical Service of the fledgling army, having obtained from army commander Maj. Gen.George B. McClellan the charter to do whatever was necessary to improve the system. The army reeled from inefficient treatment of casualties in the Seven Days Battles in June, but by the time of the Battle of Antietam in September, Letterman had devised a system of forward first aid stations at the regimental level, where principles of triage were first instituted. Basically, Letterman instituted standing operating procedures for the intake and subsequent treatment of war casualties or for first time applied management principles to battlefield medicine. He established mobile field hospitals to be located at division and corps headquarters. This was all connected by an efficient ambulance corps, established by Letterman in August 1862, under the control of medical staff instead of the Quartermaster Department. Letterman also arranged an efficient system for the distribution of medical supplies.

Letterman proved the efficiency of his system at the Battle of Fredericksburg, in which the Army of the Potomac suffered 12,000 casualties, yet the command decisions of general officers in preparation for the later Battle of Gettysburg and during the Mine Run Campaign that followed that battle compromised Letterman’s supply of medical equipment.[7][8] His system was, though, adopted by the Army of the Potomac and other Union armies after the Battle of Fredericksburg and was eventually officially established as the Procedure for intake and treatment of battlefield casualties for the entirety of the United States' armies by an Act of Congress in March 1864.

The greatest casualties for his army were suffered at the three-day Battle of Gettysburg in July 1863. To deal with more than 14,000 Union wounded, along with 6,800 Confederate wounded who were left behind, a vast medical encampment was created northeast of Gettysburg off the York Pike on the George Wolf farm, named "Camp Letterman."[9] Of the Battle of Gettysburg and his system for treating casualties, Jonathan Letterman on October 3, 1863 reported to Brig. Gen. S. Williams, A.A.G., Army of the Potomac, “Surgeon John McNulty, medical director of that corps, reports that ‘it is with extreme satisfaction that I can assure you that it enabled me to remove the wounded from the field, shelter, feed them, and dress their wounds within six hours after the battle ended, and to have every capital operation performed within twenty-four hours after the injury was received.’ I can, I think, safely say that such would have been the result in other corps had the same facilities been allowed -- a result not to have been surpassed, if equaled, in any battle of magnitude that has ever taken place.’”[10] Maj. McNulty, the Medical Director of the XII Corps (Union Army), either “had not received” or more likely had outright disobeyed orders to leave behind medical baggage wagons and, therefore, unlike many other Union medical commanders at Gettysburg had sufficient medical equipment and supplies to adequately implement Letterman’s systems at Gettysburg for the XII Corps.[11]

A military man, Letterman understood that troop’s lives are not saved just by the expedited treatment of their wounds, but, also, by their expedited travel and positioning, “The expediency of the order I, of course, do not pretend to question, but its effect was to deprive this department of the appliances necessary for the proper care of the wounded”.[12] He appreciated that command had to make hard decisions when allocating transport vehicles for the best overall benefit of the Army’s operations and soldiers. Still, Letterman was somewhat discouraged by command’s lack of support for his organization at the Battle of Gettysburg and through the Mine Run Campaign.[13] After a brief period of serving as Inspector of Hospitals in the Department of the Susquehanna, Letterman resigned from the army in December 1864 well before the end of the American Civil War and relocated to San Francisco, California, where he served as elected coroner from 1867 to 1872.[14] He published his memoirs, Medical Recollections of the Army of the Potomac, in 1866.

Death and legacy

After the death of his wife, Mary Digges Lee Letterman, he became severely depressed. He then came down with several illnesses and eventually died in San Francisco. He was only 47 years old. On November 13, 1911, the Army hospital at the Presidio was named Letterman Army Hospital in his honor. He was buried at Arlington National Cemetery. The inscription on the private memorial that was erected for him reads:

Medical Director of the Army of the Potomac, June 23, 1862 to December 30, 1863, who brought order and efficiency into the Medical Service and who was the originator of modern methods of medical organization in armies.

His wife was buried at his side. Her inscription reads: "Blessed are the dead that died in the Lord."

^Jonathan Letterman, M.D. (1866). Medical Recollections of the Army of the Potomac. New York: D. Appleton & Co., p. 155

^ House of Representatives (51st Congress, 1st Session). (1889). The War of Rebellion: A Compilation of the Official Records of the Union and Confederate Armies Series 1, Vol. 27, Part 1, Misc. Doc. No. 146. (Robert N. Scott, Compiler). Washington, D.C.: United States government Printing Office, pp. 196-197 (Google digitized April 26, 2011)

^ House of Representatives (51st Congress, 1st Session). (1889). The War of Rebellion: A Compilation of the Official Records of the Union and Confederate Armies Series 1, Vol. 27, Part 1, Misc. Doc. No. 146. (Robert N. Scott, Compiler). Washington, D.C.: United States government Printing Office, pp. 195-199 at p. 197, “No. 16”, Report of Jonathan Letterman, U.S. Army Medical Director, Army of the Potomac, to Brig. Gen. S. Williams, A.A.G., Army of the Potomac, October 3, 1863(Google digitized April 26, 2011)

^Jonathan Letterman, M.D. (1866). Medical Recollections of the Army of the Potomac. New York: D. Appleton & Co., p. 157

^House of Representatives (51st Congress, 1st Session). (1889). The War of Rebellion: A Compilation of the Official Records of the Union and Confederate Armies Series 1, Vol. 27, Part 1, Misc. Doc. No. 146. (Robert N. Scott, Compiler). Washington, D.C.: United States government Printing Office, pp. 196 (Google digitized April 26, 2011)

^Jonathan Letterman, M.D. (1866)Medical Recollections of the Army of the Potomac. New York: D. Appleton & Co., pp. 152-157